Free 795 - Kentucky


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State: Kentucky
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AOC-795 Rev. 8-99 Page 1 of 2

Doc. Code: PRMT

Case No.______________________ Court_________________________

Commonwealth of Kentucky Court of Justice KRS 387.620

PETITION FOR RELIEF, MODIFICATION OR TERMINATION
) ) ) ) ) )

County_______________________

COMMONWEALTH OF KENTUCKY Petitioner VS. _____________________________________________ Respondent

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Comes the Petitioner and requests the Court to u terminate u modify as follows:

u

The order of u partial disability u disability entered on __________________________________________ be

u terminated u modified as follows: u u
1.

___________________________________________________________

________________________________________________________________________________________ To remove the present fiduciary and replace with _________________________________________________. To renew the appointment of the present fiduciary for a period of ____________________________________.

In support of this request, Petitioner states: The Respondent's address: ______________________________________________________________________ In custody of: __________________________________________________________________________________ 2. Respondent's present fiduciary: ___________________________________________________________________ Address: _____________________________________________________________________________________ Appointed on: _________________________________________________________________________________ As:

u u

Limited Guardian Guardian

u u

Limited Conservator Conservator

3.

The Respondent's u Durable Power of Attorney u Health Care Surrogate is: _____________________________________________ Address _____________________________________________ _____________________________________________

_____________________________________________ Name

4.

Respondent's next of kin are: Name Address ______________________________ ______________________________ _______________________________ Relationship _____________________________ _____________________________ _____________________________

______________________________ ______________________________ ______________________________ 5.

The facts and reasons supporting this request: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

AOC-795 Rev. 8-99 Page 2 of 2

Doc. Code: PRMT

WHEREFORE, the Petitioner requests that this court conduct a hearing within thirty (30) days of the filing of this petition. If the foregoing petition is for a renewal of the appointment of a limited guardian or conservator, it shall be accompanied by verified affidavits of a physician, a psychologist, or a social worker in support of same pursuant to KRS 387.610.

_____________________________________________ Petitioner _____________________________________________ Address _____________________________________________ Relationship to Respondent

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SUBSCRIBED and SWORN to before me this ___________ day of _____________________________, ________.

_____________________________________________ Name/Title _____________________________________________ County, Kentucky

To be completed if Petitioner is represented by counsel:

_____________________________________________ Signature of Attorney _____________________________________________ Address of Attorney _____________________________________________ Telephone Number

An attested copy of this Petition was mailed this date to the Respondent, the attorney of record, the county attorney and all persons named in the Petition.

_________________________________________ Date

_____________________________________________ Signature